A Conversation with . . . Paul Schmelzer

Treatment planning plays a critical role in maximizing the benefits and minimizing the risks of treatment delivery to the patient, yet many of the more advanced imaging sequences are absent from clinical practices.

In the following discussion, rt image sits down with Paul Schmelzer, president and CEO of Prism Clinical Imaging Inc. to find out how his company is making strides to introduce advanced MRI into the clinical setting.


rt image: Who designed and developed Prism, and why is it unique?

Paul Schmelzer: Advanced MR imaging sequences like functional MRI (fMRI), diffusion tensor imaging (DTI), MR spectroscopy, and perfusion have been around for a number of years.

Unfortunately, few patients benefited from these advances for lack of a practical way to translate them into general clinical practice. Advanced MR imaging was limited to academic medical center research laboratories.

Researchers at the [Milkwaukee-based] Medical College of Wisconsin saw tremendous clinical value in multimodality, multiparameter imaging. Prism Clinical Imaging was created to commercialize their vision of a suite of software products designed to translate advanced imaging into general clinical practice.

What makes Prism different is that it brings multiple MR sequences together with conventional anatomical images to deliver powerful clinical value to patients and the clinicians who treat them.


image: Imaging technology continues to evolve rapidly. How does Prism software help plan and better treat brain tumors?

Schmelzer: Prism produces breakthrough visualization based on registered ‘decks’ of anatomical, functional, and physiological images. For the first time, physicians are able to see multiple image volumes in a single viewing space.

In an application like functional brain mapping, they are able to see a pathology – such as a tumor – in relation to active functional tissue and the underlying anatomy. Physicians can then devise treatment plans that avoid functional tissue and minimize the risk of complications.

Physiological sequences, including spectroscopy and perfusion, are also useful in monitoring treatment efficacy and post-treatment follow-up. These sequences improve the definition of tumor boundaries and grade assessment in treatment planning.

Prism integrates all these sequences for the clinician, freeing the physician to focus on treatment strategy instead of having to assimilate complex information from multiple sources.


image: How does Prism improve quality of care?

Schmelzer: Prism helps physicians reduce treatment-related complications by showing them how to avoid valuable tissue. Prism maps show active tissues that control a patient’s cognitive, motor or sensory functions and also identify white-matter tracks that make up the brain’s functional network.

Using these maps, physicians can protect valuable tissue consistent with positive clinical results, while being aggressive in areas of limited or no risk.


image: What evidence do you have so far that indicates using Prism to treat brain tumors can reduce the risk of complication and patient deficiencies from treatment?

Schmelzer: We have preliminary indications that post-treatment deficits are reduced. Our customers and others have now done enough cases to make credible inferences about the value of fMRI and DTI in pre-surgical mapping. We expect to see one or more clinical studies published this year that demonstrate the value of fMRI and DTI in treatment planning.

We believe these studies will show that fMRI and DTI mapping should be the standard of care for treatment planning in radiosurgery, as well as conventional neurosurgery. Prism provides the practical tools needed to deliver that standard in general clinical practice.


image: Imaging technology is not always easily integrated into clinical workflow. How does Prism differ from other mapping technologies?

Schmelzer: Prism makes advanced imaging practical. The software suite encompasses image acquisition, post-processing clinical viewing, and exportation to treatment systems.

Trained technologists operate the process until images are ready for interpretation by a physician. Prism interoperates with existing imaging modalities, DICOM infrastructure, PACS, and treatment systems in radiation oncology and neurosurgery.

Prism can be deployed as an integrated software suite or as an application service. In the application service model, a provider installs Prism acquisition and viewing software.

Post-processing and quality assurance services are provided by Prism on a per-case basis from a high-performance, Tier 1 datacenter 24 hours a day, 365 days a year. This service makes advanced imaging accessible to regional healthcare providers and outpatient imaging centers.


image: How does Prism improve clinical productivity?

Schmelzer: Advanced imaging studies, like fMRI, haven’t been practical in general clinical practice because of the time and expertise required to prepare the data. One of our luminary sites recently told us that it took a PhD seven hours to prepare a mapping case comparable to a study Prism produces in less than 20 minutes.

By displaying multiple image volumes interactively in the same viewing space, physicians can see critical spatial relationships faster and more accurately.

The ability to export these images to treatment systems promotes better, faster treatment planning. Functional mapping can also save time in the OR since functional maps complement conventional methods of cortical localization, allowing surgeons to simply confirm pre-surgical findings. This can shorten surgical procedures, which is safer for the patient and improves clinical productivity.


image: Prism organizes images into multi-layered decks; how does this help radiation oncologists, neuroradiologists, and neurosurgeons?

Schmelzer: Prism gives physicians information they haven’t been able to get before, presented in a way they’ve never seen. It allows physicians to quickly establish critical spatial relationships that improve accuracy in treatment planning and delivery.

Radiation oncologists and neurosurgeons rely on their knowledge of neuroanatomy for functional information when treating a patient. The problem is that when you introduce a mass, such as a tumor, in a patient’s brain, tissue and functions may shift.

The anatomy book goes out the window, and the physician is forced to fly on the instruments of experience. Prism maps change all that. They allow the physician to see eloquent cortex and white-matter tracks that are actually proximate to the treatment area.


image: How do hospitals benefit from Prism?

Schmelzer: Patients with brain tumors and other neurological disorders are informed consumers of healthcare services. And patients who hear about advanced neuroimaging want to be treated by physicians using the latest innovation in technology and technique.

In the hands of skilled clinicians, Prism can help establish a provider organization as a center of excellence in the treatment of brain tumors and other neurological disorders, driving patient volumes and enhancing revenue.


image: What other clinical applications will benefit from advanced imaging and Prism software?

Schmelzer: Prism benefits from the continuing research efforts of our founders, medical advisors, and an active pursuit of [National Institutes of Health] grants. We believe Prism core technologies will translate to anatomical structures and organ systems beyond brain.


— rt image